Immunohistochemical Assessment of Lymphovascular Invasion in Stage I Colorectal Carcinoma: Prognostic Relevance and Correlation With Nodal Micrometastases
Immunohistochemical Assessment of Lymphovascular Invasion in Stage I Colorectal Carcinoma: Prognostic Relevance and Correlation With Nodal Micrometastases
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DOI：
10.1097/pas.0b013e31822d3008
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发表时间：
2012-01-01
影响因子：
5.6
通讯作者：
Barresi, Gaetano
中科院分区：
文献类型：
--
作者：
Barresi, Valeria;Bonetti, Luca Reggiani;Barresi, Gaetano
一些研究表明，隐匿淋巴结转移（微转移）的存在与I期结直肠癌的不良临床病程有关。在此，我们分析了一系列I期结直肠癌中淋巴结微转移与淋巴血管侵袭（LVI）或淋巴管密度（LVD）的相关性；该队列包括随访期间以疾病进展为特征或不以疾病进展为特征的病例。在这些病例中，通过免疫组织化学检测淋巴管特异性标志物D2-40来证实LVI和LVD。LVI在以微转移（P < 0.0001）、高瘤周LVD （P < 0.0001）和疾病进展（P < 0.0001）为特征的结直肠癌中更为常见。进展风险分析表明，淋巴结微转移和LVI是显著的、阴性的、独立的预后参数，与I期结直肠癌较短的无病生存期相关（P = 0.0001; P = 0.0242）。总之，在这项研究中，我们首次证明了LVI与I期结直肠癌的淋巴结隐匿性转移有显著相关性。鉴于LVI在这种肿瘤中具有重要的、独立的预后价值，与耗时的微转移评估相比，LVI的检测可能是一种更快、更便宜的工具，可以选择可能受益于辅助全身治疗的高危患者。此外，LVI的评估可用于确定采用保守的局部切除技术治疗的肿瘤累及淋巴结的可能性，这种技术没有提供用于组织学检查的区域淋巴结。
Several studies have suggested that the presence of occult nodal metastases (micrometastases) is related to adverse clinical course in stage I colorectal carcinoma. Herein we analyzed the correlation between nodal micrometastases and lymphovascular invasion (LVI) or lymphatic vessel density (LVD) in a series of stage I colorectal carcinomas; the cohort included cases characterized or not characterized by disease progression during the follow-up. In these cases, LVI and LVD were evidenced through the immunohistochemical detection of the specific marker for lymphatic vessels, D2-40. LVI was significantly more frequent in colorectal carcinomas characterized by the presence of micrometastases (P < 0.0001), high peritumoral LVD (P < 0.0001), and disease progression (P < 0.0001). The analysis for progression risk indicated that nodal micrometastases and LVI were significant, negative, independent prognostic parameters associated with shorter disease-free survival of stage I colorectal cancer (P = 0.0001; P = 0.0242). In conclusion, in this study we demonstrated for the first time that LVI is significantly associated with nodal occult metastases in stage I colorectal carcinoma. In the light of its significant, independent, prognostic value in this neoplasia, the detection of LVI may represent a faster and cheaper tool compared with the time-consuming evaluation of micrometastases to select high-risk patients who may benefit from adjuvant systemic treatment. Furthermore, the assessment of LVI may be applied to establish the likelihood of nodal involvement from carcinomas treated with conservative local excision techniques, which provide no regional nodes for histologic examination.